Romantic Era And The Byronic Hero English Literature Essay

Romantic Era And The Byronic Hero English Literature Essay The Romantic Era and the Byronic Hero. During the eighteenth and early nineteenth centuries, literature and art as well as political philosophy were deeply influenced by new ideas about individualism and citizen rights. The American and French Revolutions illustrate the power and volatility of these new ideas. Although the term Romantic wasnt applied to this period until many decades later, the writers of this period expressed a sense of collective intellectual energy that they called the spirit of the age.†It was a time for questioning the status quo, challenging conventions of social hierarchy, and elevating the value of the common man and woman. Romantic writers reflected on the beauty of the natural world as a means of discovering, illuminating, and articulating their own insights about human nature. Their writing frequently included scathing critiques of social injustices, mainly associated with growing urbanization; meanwhile, they idealized rural landscapes and lifestyle s. Many of these authors were profoundly influenced by Miltons poetic works, especially  Paradise Lost. For example, William Blakes  Songs of Innocence and Experience  juxtaposes poetic visions of the world first through the eyes of a child, or innocent, and then through experienced eyes that recognize sin and inhumanity as part of the human fallen condition. As mentioned in the readings, Blake argued that Miltons Satan was the true hero of  Paradise Lost, and many of his contemporaries agreed with him. Miltons Satan inspired a new figure in English literature: the Byronic Hero. In this lesson, we will read several defenses of this rebellious and misunderstood, tragic character. In particular, we will investigate how this figure informs Mary Shelleys famous gothic novel,  Frankenstein. During the Romantic period, the art form of the novel became increasingly popular, in conjunction with a growing reading public. Some of the most famous and influential novels of this era include Jane Austins satiric novels of sensibility and manners, Walter Scotts historical novels, and Mary Shelleys critique of science and society in  Frankenstein. Most of us are familiar with the monstrous figure of Frankenstein from popular culture: film and television images. Mary Shelleys original creature was conceived in the aftermath of the French Revolution and the subsequent bloodshed that shocked and disillusioned many of the initial supporters of this revolution. Note that the name Frankenstein refers specifically to the scientist, Victor Frankenstein, who created a living Creature. The relationship between Victor and the Creature offers a complex commentary on the duties and responsibilities of both a creator and the created, which invites comparisons with Miltons depiction of the rel ationships between God, Adam and Eve, and Satan. Shelley interweaves the Biblical narrative of the Fall in Genesis with the Greek myth of Prometheus, another creation myth about duty, betrayal and punishment. Furthermore,  Frankenstein  explores themes of pride and ambition by combining these grand epic narratives with Shelleys own personal experiences of procreation, parenting, and death. Lesson Four Reading Assignment Readings: In  Masters of British Literature  (Longman, Vol. B), skim â€Å"The Romantics and their Contemporaries†, (pp. 3-28). Also read: William Wordsworth, â€Å"The World is too much with us†; â€Å"London 1802† (231-2); â€Å"Manfred’ and Its Time: The Byronic Hero† (386-7); and Coleridge, â€Å"Satanic Pride and Rebellious Self-Idolatry† (392-3) In the Longman Cultural Edition of Mary Shelley’s  Frankenstein, please read Susan Wolfson’s introduction (pp. xvii-xxii) before you read the novel. Then read Mary Shelley’s  Frankenstein  (the 1818 edition). And, then read the excerpts in â€Å"God, Adam, and Satan† (301-322). Reading Questions: As you read the novel, consider the following questions: What is the effect on the reader of learning about Victor’s story through the third-person, Walton, and his letters to his sister? On page 34, Victor images the gratitude that his creation will feel towards him. How does he respond, on page 37, when he actually animates the body of his creation? How does Victors initial vision of being a creator differ from the reality throughout the rest of his tale? How would you describe Victors character? How is he perceived by other characters in the novel? At various points in the narrative do you find your allegiance shift from Victor to the Creature, or vice versa? Why might the author want the reader to feel sympathy for each of these characters? Traditionally, a novel will have a protagonist, or hero, and an antagonist, or villain. Who is the protagonist and who is the antagonist in this work? Consider how this narrative evokes the story of the Garden of Eden, the Forbidden Fruit of the Tree of Knowledge, the desire to be godlike, and the Fall from Grace. What is the effect of these allusions? How does this novel view science and the quest for knowledge? Does Walton learn anything from Victor’s tale? Is it significant that he acquiesces to his men’s desires to return to England? Lesson Four Writing Assignment Essay Assignment: Select one of the following essay prompts. After considering how you would answer each of the questions in the prompt, craft a thesis based on your answers and write a 5-page essay, supporting your selected topic. In Chapter VII of volume II, the Creature finds a bag of books, including Milton’s  Paradise Lost. How is the Creature affected by reading this epic poem as â€Å"true history† (98)? Shelley invites us to compare Victors creation with Miltons retelling of Genesis. How does this comparison influence our interpretation of  Frankenstein?  Is the Creature more similar to Adam or to Satan? Does Shelley’s novel encourage us to view Satan as a heroic rebel or the arch-fiend? Explain your answers with evidence from both  Paradise Lost  and  Frankenstein  and additional readings about the Romantic poets. Milton embellishes much of the Genesis story, but regarding the punishment of Eve, he restates the King James Bible text (Genesis 2:16) with almost no alteration or addition; Miltons God decrees to Eve: Thy sorrow I will greatly multiply By thy conception; children thou shalt bring In sorrow forth, and to thy husbands will Thine shall submit, he over thee shall rule. (Book X, lines 193-6) Mary Shelleys mother, Mary Wollstonecraft, was a famous feminist who died from complications of childbirth soon after Mary was born. Mary Shelley suffered miscarriages and the early deaths of several of her own children. Many critics hypothesize that Shelleys experiences of birth and death greatly influenced her creation of  Frankenstein. They argue that Victors obsession with creating a human represents a desire to possess and/or circumvent human reproduction. In your essay, connect Victors desire to supplant human procreation to Eves temptation to possess knowledge and become godlike. How are their transgressions similar and different? How are their punishments similar and different? You might consider the theory of the Fortunate Fall† in your discussion. Discuss how the Romantic Poets interpreted Miltons  Paradise Lost. Explain the political and social events that influenced their ideas about God and Satan.   Refer to at least two examples from the poets writings in the Reading Assignment, as well as the scholarly commentary.  Then, consider Mary Shelleys incorporation of  Paradise Lost  into  Frankenstein.   Does her adoption of Milton reflect or challenge the ideas of what Susan Wolfson terms Romantic Satanism (p 301 in the Longman Cultural Edition of  Frankenstein)?   In other words, how does Shelleys novel respond to the Romantic Poets interpretation of Miltons epic poem? Paradise Lost (Paradise Lost) revealed human sin and corruption. The poem describes the rebellious angels of Satan. Adam and Eve were possessed by Satan, ate the fruit from the tree of the knowledge of good and evil that God prohibited eating. Finally, Satan and his cohorts were turned into snakes. Adam and Eve were expelled from the garden of Eden. The poem reflects the poets freedom to pursue the lofty spirit. Satan had gathered many rebel angels under him. The poem describes how Satan and his angels fall into hell by the thunder and the heat of fire, after a while, he wakes from dizziness. Satan awakens all the same angles in Heaven, and they got up. Satan comforts them in the speech, inspiring them, finally he told them, according to an ancient prophecy or report in heaven, there is a new world and a new creature to be created. So they decided to hold a plenary session of the prophecy, and discussed countermeasures. At the beginning of the meeting, the first question is debated: it is necessary to take a risk of war to restore the kingdom of heaven. The final three take a proposal, which is Satan mentioned, to explore whether the prophecy or hagiography is correct. According to legend, the God is creating a new world and a new species, a creature with not much difference between them. The difficult question is who will be sent to do the difficult exploration. Their leader Satan alone bears the task, winning peoples admiration and applause. After the meeting, other members pursue pleasure randomly. In the journey of Satan through the hell gate, the door is closed, the person in charge of the gate talked with Satan. Finally, the man opened the door. Satan saw a big pit between the hell and the heaven, which is chaotic world. Under the guidance of the ordeal, he only went to see what hes looking for in new world. When Satan went into the new world, God seated on a throne saw. The God refers to the prophecy that Satan will seduce human, and his plot will succeed. Human beings are free, and there is resistance to temptation, sweeping all slander to justice, the ability of wisdom. He also claims; people commit crime because of many reasons. Satan is wandering edge of a wasteland for a while in the new universe. Seen from what is called empty border place, people and things soaring; then, he would fly to the sun. He first pretends to deform for junior angels, sincerely, to see a new world and live in one of these people. Under Youlies guidance, he flies to paradise. Satan finally reached the new world, and it landed in a survey of the garden of Eden place, where it has been close to his destination, he alone takes bold adventure, to be against God, man. The moment he got into all kinds of confusion, his heart occupies many strong emotions: jealousy, fear, despair and so on. But in the end he decided to implement the evil plans, along the radial paradise. He crossed the border, into a cormorant, squatting on the tree of life the highest office park, looking around. It is his first sight of Adam and Eve. His wonder at their beautiful appearance and the happy scene make him determined to make them fall. After eavesdropping on their conversation, knowing they were forbidden to eat the fruits from the park tree of knowledge, which can let them under penalty of death. He decided to start, entice them to transgress. He leaves here, trying to further understand the situation. As night falls, Adam and Eve want Gabriel to send an angel, sending two power ful angels to Adams house, to protect the sleep of Adam and Eve, lest suffering from evil. They found him on the ear of Eve, in her dream to seduce her. The devil was arrested on the spot, brought before Gabriel. When questioned, his attitude is very strong; but for the warning, flies out of paradise. After snooping the Satan has sinister motives, like a lost soul in the night and returns to paradise, into the inside body of sleeping serpent. In the morning Adam and Eve are out to work, and each person does the job by their own. Adam did not approve of it, worrying about the danger, which had been previously warned the enemy will seduce her at her when she was alone. Eve would not be as strong and decisive enough, so she wants to separate labor, to test her ability. Adam finally gave in. Seen her alone, snake skillfully came to her, close to her; at first look, then opening, said a lot of flattery, flattering her how outstanding she is. Eve, listening to what the snake spoke, became very curious, asking how he can speak like human beings, but also can also understand so well. The snake answered, that is because of eating fruit from a certain tree in the garden, which can also make people more rational. Eve asked him to have a look of that tree. She looks, what is unexpected is tha t this tree is the right tree of the knowledge that the God forbids her to eat. The snake is of strong courage, using many reasons to persuade her to try. She finally tries, feeling very delicious. She thought to let Adam have a taste of this thing. But she hesitated, finally decided to give him this fruit, and advised him to eat. Adam was frightened at first because this is forbidden. But finally he decided to eat the fruit. The forbidden fruit in the two persons takes effect, they feel ashamed; and they find something to cover their nakedness. Then two people quarrel with one another. God said: they are unable to prevent Satan going into the park. Sin and death, sitting in the gate of hell, are excited to find Satan succeeds in the new world of conspiracy, so they are determined to follow their father Satan. They followed their path according to Satan, building a road or bridge on the chaotic world. As they prepare to leave back to hell, they meet Satan, returning after a conceited triumphant. Satan successfully indulges in verbiage before all the people for human conspiracy. Audience only applauds. And they, like in the paradise, are suddenly transformed into a snake. In their eyes, the scene of the forbidden tree appeared, they stretched to pick the fruit, but full of dust.Sin and death still continue their work. Adam came to know of his degraded condition, deeply sad, and Eve comfort is also rejected by him. Eve adheres to persuade him. In order to avoid the curse fallen to his descendants, she advised Adam to use violence; he strongly opposed, but reminded her of her sons to revenge snake, thereby holding good hope, encouraging her to pray with him to appease the anger of god. Then Satan, in the snakes image, committed a terrible, hateful deception behavior in the garden. Milton has been very clever in describing this story. He uses the story to deliver a spirit of freedom. And he makes full use of this story to show his ideas.

Nursing: Epidemiology and Health

U N I T Concepts of Health and Disease arly peoples were considered long-lived if they reached 30 years of age—that is, if they survived infancy. For many centuries, infant mortality was so great that large families became the tradition; many children in a family ensured that at least some would survive. Life expectancy has increased over the centuries, and today an individual in a developed country can expect to live about 71 to 79 years. Although life expectancy has increased radically since ancient times, human longevity has remained fundamentally unchanged.The quest to solve the mystery of human longevity, which appears to be genetically programmed, began with Gregor Mendel (1822–1884), an Augustinian monk. Mendel laid the foundation of modern genetics with the pea experiments he performed in a monastery garden. Today, geneticists search for the determinant, or determinants, of the human life span. Up to this time, scientists have failed to identify an aging gene th at would account for a limited life span. However, they have found that cells have a ? nite reproductive capacity. As they age, genes are increasingly unable to perform their functions.The cells become poorer and poorer at making the substances they need for their own special tasks or even for their own maintenance. Free radicals, mutation in a cell’s DNA, and the process of programmed cell death are some of the factors that work together to affect a cell’s functioning. I E CHAPTER Concepts of Health and Disease Georgianne H. Heymann Carol M. Porth 1 ogy. There has been an increased knowledge of immune mechanisms; the discovery of antibiotics to cure infections; and the development of vaccines to prevent disease, chemotherapy to attack cancers, and drugs to control the manifestations of mental illness.The introduction of the birth control pill and improved prenatal care have led to decreased birth rates and declines in infant and child mortality. The bene? ts of scienc e and technology also have increased the survival of infants born prematurely and of children with previously untreatable illnesses, such as immunode? ciency states and leukemia. There also has been an increase in the survival of very seriously ill and critically injured persons of all age groups.Consequently, there has been an increase in longevity, a shift in the age distribution of the population, and an increase in age-related diseases. Coronary heart disease, stroke, and cancer have now replaced pneumonia, tuberculosis, and diarrhea and enteritis—the leading causes of death in the 1900s. This chapter, which is intended to serve as an introduction to the book, is organized into four sections: health and society, historical perspectives on health and disease, perspectives on health and disease in individuals, and perspectives on health and disease in populations.The chapter is intended to provide the reader with the ability to view within a larger framework the historical aspects of health and disease and the relationship of health and disease to individuals and populations, and to introduce the reader to terms, such as etiology and pathogenesis, that are used throughout this text. HEALTH AND SOCIETY HEALTH AND DISEASE: A HISTORICAL PERSPECTIVE The In? ence of Early Scholars The Nineteenth Century The Twentieth Century The Twenty-First Century PERSPECTIVES ON HEALTH AND DISEASE IN INDIVIDUALS Health Health and Disease as States of Adaptation Disease Etiology Pathogenesis Morphology Clinical Manifestations Diagnosis Clinical Course PERSPECTIVES ON HEALTH AND DISEASE IN POPULATIONS Epidemiology and Patterns of Disease Prevalence and Incidence Morbidity and Mortality Determination of Risk Factors The Framingham Study The Nurses’ Health Study Natural History Levels of Prevention Evidence-Based Practice and Practice Guidelines e concepts of what constituted health and disease at the beginning of the last century were far different from those of thi s century. In most of the industrialized nations of the world, people now are living longer and enjoying a healthier lifestyle. Much of this has been made possible by recent advances in science and technol- T Health and Society Everyone who is born holds dual citizenship in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obligated, at least for a spell, to identify ourselves as citizens of that other place. 3 4 UNIT I Concepts of Health and Disease After completing this section of the chapter, you should be able to meet the following objectives: ? Describe the concepts used to establish belief systems within a community and the effects on its health care practices ? Identify a disease believed to be generated by speci? c emotions and the characteristics ascribed to it ? Explain how mythologizing disease can be detrimental to individuals in a society There is a long history that documents the concern of humans for their own health and well-being and that of their community.It is not always evident what particular beliefs were held by early humans concerning health and disease. Still, there is evidence that whenever humans have formed social groups, some individuals have taken the role of the healer, responsible for the health of the community by preventing disease and curing the sick. In prehistoric times, people believed that angry gods or evil spirits caused ill health and disease. To cure the sick, the gods had to be paci? ed or the evil spirits driven from the body. In time, this task became the job of the ealers, or tribal priests. They tried to pacify the gods or drive out the evil spirits using magic charms, spells, and incantations. There also is evidence of surgical treatment. Trephining involved the use of a stone instrument to cut a hole in the skull of the sick person. It is believed that this was done to release spirits responsible for illness. Prehistoric h ealers probably also discovered that many plants can be used as drugs. The community as a whole also was involved in securing the health of its members.It was the community that often functioned to take care of those considered ill or disabled. The earliest evidence of this comes from an Old Stone Age cave site, Riparo del Romio, in southern Italy. There the remains of an adolescent dwarf were found. Despite his severe condition, which must have greatly limited his ability to contribute to either hunting or gathering, the young man survived to the age of 17 years. He must have been supported throughout his life by the rest of the community, which had incorporated compassion for its members into its belief system. Communities such as this probably existed throughout prehistory; separated from each other and without any formal routes of communication, they relied on herbal medicines and group activity to maintain health. Throughout history, peoples and cultures have developed their he alth practices based on their belief systems. Many traditions construed sickness and health primarily in the context of an understanding of the relations of human beings to the planets, stars, mountains, rivers, spirits, and ancestors, gods and demons, the heavens and underworld.Some traditions, such as those re? ected in Chinese and Indian cultures, although concerned with a cosmic scope, do not pay great attention to the supernatural. Over time, modern Western thinking has shed its adherence to all such elements. Originating with the Greek tradition—which dismissed supernatural powers, although not environmental in? uences—and further shaped by the In? uences of zodiac signs on the human body. (Courtesy of the National Library of Medicine) ourishing anatomic and physiologic programs of the Renaissance, the Western tradition was created based on the belief that everything that needed to be known essentially could be discovered by probing more deeply and ever more minu tely into the ? esh, its systems, tissues, cells, and DNA. 3 Through Western political and economic domination, these health beliefs now have powerful in? uence worldwide. Every society has its own ideas and beliefs about life, death, and disease. It is these perceptions that shape the concept of health in a society.Although some customs and beliefs tend to safeguard human communities from disease, others invite and provoke disease outbreaks. The beliefs that people have concerning health and disease can change the destiny of nations. The conquering of the Aztec empire may be one example. Historians have speculated how Hernando Cortez, starting off with fewer than 600 men, could conquer the Aztec empire, whose subjects numbered millions. Historian William H. McNeill suggests a sequence of events that may explain how a tiny handful of men could subjugate a nation of millions.Although the Aztecs ? rst thought the mounted, gunpowered Spaniards were gods, experience soon showed CHAPTER 1 Concepts of Health and Disease 5 otherwise. Armed clashes revealed the limitations of horse? esh and of primitive guns, and the Aztecs were able to drive Cortez and his men from their city. Unbeknownst to the Aztecs, the Spaniards had a more devastating weapon than any ? rearm: smallpox. An epidemic of smallpox broke out among the Aztecs after their skirmishes with the Spaniards.Because the population lacked inherited or acquired immunity, the results were catastrophic. It is presumed that a quarter to a third of the population died from the initial onslaught. Even more devastating were the psychological implications of the disease: it killed only American Indians and left Spaniards unharmed. A way of life built around the old Indian gods could not survive such a demonstration of the superior power of the God the Spaniards worshipped. It is not hard to imagine then that the Indians accepted Christianity and submitted meekly to Spanish control. Although we live in an age of science , science has not eliminated fantasies about health; the stigmas of sickness and the moral meanings that they carry continue. Whereas people in previous centuries wove stories around leprosy, plague, and tuberculosis to create fear and guilt, the modern age has created similar taboos and mythologies about cancer and acquired immunode? ciency syndrome (AIDS). The myth of tuberculosis (TB) was that a person who suffered from it was of a melancholy, superior character— sensitive, creative, a being apart.Melancholy, or sadness, made one â€Å"interesting† or romantic. The general perception of TB as â€Å"romantic† was not just a literary device. It was a way of thinking that insinuated itself into the sensibilities and made it possible to ignore the social conditions, such as overcrowding and poor sanitation and nutrition, that helped breed tuberculosis. The infusion of beliefs into public awareness often is surreptitious. Just as tuberculosis often had been regard ed sentimentally, as an enhancement of identity, cancer was regarded with irrational revulsion, as a diminution of the self. Current accounts of the psychological aspects of cancer often cite old authorities, starting with the Greek physician Galen, who observed that â€Å"melancholy women† are more likely to get breast cancer than â€Å"sanguine women. † Grief and anxiety were cited as causes of cancer, as well as personal losses. Public ? gures such as Napoleon, Ulysses S. Grant, Robert A. Taft, and Hubert Humphrey have all had their cancers diagnosed as the reaction to political defeat and the end to their political ambitions. Although distress can affect immunologic responsiveness, there is no scienti? evidence to support the view that speci? c emotions, or emotions in general, can produce speci? c diseases—or that cancer is the result of a â€Å"cancer personality,† described as emotionally withdrawn, lacking self-con? dence, and depressive. These di sease mythologies contribute to the stigmatizing of certain illnesses and, by extension, of those who are ill. The beliefs about health and disease have the power to trap or empower people. They may inhibit people from seeking early treatment, diminish personal responsibility for practicing healthful behaviors, or encourage fear and social isolation.Conversely, they also can be the impetus for compassion to those who are ill, for commitment to improving one’s own health, and for support of efforts to improve the health status of others. In summary, what constitutes health and disease changes over time. Prehistoric times were marked by beliefs that angry gods or evil spirits caused ill health and disease. To cure the sick, the gods had to be paci? ed or the evil spirits driven from the body. Tribal healers, or priests, emerged to accomplish this task. Prehistoric healers used a myriad of treatments, including magic charms, spells, and incantations; surgical treatment; and plan t medicines.Throughout history, the concept of health in a society has been shaped by its beliefs about life, death, and disease. Some beliefs and customs, such as exhibiting compassion for disabled community members, tend to safeguard human communities and increase the quality of life for all community members. Others invite and provoke disease outbreaks, such as myths about the causes of disease. Even though science and technology have advanced the understanding and treatment of disease, misconceptions and fantasies about disease still arise.In previous centuries, diseases such as leprosy, plague, and tuberculosis were fodder for taboos and mythologies; today, it is cancer and AIDS. The psychological effects of disease mythologies can be positive or negative. At their worst, they can stigmatize and isolate those who are ill; at their best, they can educate the community and improve the health of its members. Health and Disease: A Historical Perspective After completing this sectio n of the chapter, you should be able to meet the following objectives: Describe the contributions of the early Greek, Italian, and English scholars to the understanding of anatomy, physiology, and pathology ? State two important advances of the nineteenth century that helped to pave the way for prevention of disease ? State three signi? cant advances of the twentieth century that have revolutionized diagnosis and treatment of disease ? Propose developments that will both hamper and contribute to the promotion of health and the elimination of disease in the twenty-? rst century It has been said that those who do not know history are condemned to repeat it.There are many contributors to the understanding of how the body is constructed and how it works, and what disease is and how it can be treated, which in turn leads to an understanding of what health is and how can it be maintained. Much of what we take for granted in terms of treating the diseases that af? ict humankind has had its origin in the past. Although they are seemingly small contributions in terms of today’s scienti? c advances, it is the knowledge 6 UNIT I Concepts of Health and Disease produced by the great thinkers of the past that has made possible the many things we now take for granted.THE INFLUENCE OF EARLY SCHOLARS Knowledge of anatomy, physiology, and pathology as we now know it began to emerge with the ancient Greeks. They were the ? rst to recognize the distinction between internal and external causes of illness. To Hippocrates and his followers, we owe the foundations of the clinical principles and the ethics that grew into modern medical science. Hippocrates (460–377 BC) was a blend of scientist and artist. He believed that disease occurred when the four humors—blood from the heart, yellow bile from the liver, black bile from the spleen, and phlegm from the brain—became out of balance.These humors were said to govern character as well as health, producing phl egmatic, sanguine, choleric, and melancholic personalities. This belief paralleled the even older Chinese tradition, which was founded on the complementary principles of yin (female principle) and yang (male), whose correct proportions were essential for health. Hippocrates is identi? ed with an approach to health that dictated plenty of healthy exercise, rest in illness, and a moderate, sober diet. It was Aristotle (384–322 BC) who, through his dissection of small animals and description of their internal Hippocrates: A blend of scientist and scholar. Courtesy of the National Library of Medicine) anatomy, laid the foundations for the later scrutiny of the human body. For Aristotle, the heart was the most important organ. He believed it to be the center of the blood system as well as the center of the emotions. However, Aristotle’s main contributions were made to science in general. The person who took the next major step was Galen (AD 129–199), a physician to t he emperors and gladiators of ancient Rome. Galen expanded on the Hippocratic doctrines and introduced experimentation into the study of healing. His work came to be regarded as the encyclopedia of anatomy and physiology.He demoted the heart—in his view, the liver was primary for venous blood, whereas the seat of all thought was the brain. He described the arteries and veins and even revealed the working of the nervous system by severing a pig’s spinal cord at different points and demonstrating that corresponding parts of the body became paralyzed. According to Galen, the body carried three kinds of blood that contained spirits charged by various organs: the veins carried â€Å"natural spirit† from the liver; the arteries, â€Å"vital spirit† from the lungs; the nerves, â€Å"animal spirit† from the brain. The heart merely warmed the blood.After Galen’s death, however, anatomic research ceased, and his work was considered infallible for almo st 1400 years. As the great medical schools of universities reformed the teaching of anatomy in the early 1500s and integrated it into medical studies, it became apparent to anatomists that Galen’s data—taken from dogs, pigs, and apes—often were riddled with error. It was only with the work of Andreas Vesalius (1514–1564) that Galen’s ideas truly were challenged. Vesalius, professor of anatomy and surgery at Padua, Italy, dedicated a lifetime to the study of the human body.Vesalius carried out some unprecedentedly scrupulous dissections and used the latest in artistic techniques and printing for the more than 200 woodcuts in his De Humani Corporis Fabrica (â€Å"On the Fabric [Structure] of the Human Body†). He showed not only what bodily parts looked like but also how they worked. The book, published in 1543, set a new standard for the understanding of human anatomy. With this work, Vesalius became a leading ? gure in the revolt against Gal en’s teachings. One of the most historically significant discoveries was made by William Harvey (1578–1657), an English physician and physiologist.He established that the blood circulates in a closed system impelled mechanically by a â€Å"pumplike† heart. He also measured the amount of blood in the circulatory system in any given unit of time—one of the ? rst applications of quantitative methods in biology. Harvey’s work, published in On the Motion of the Heart and Blood in Animals (1628), provided a foundation of physiologic principles that led to an understanding of blood pressure and set the stage for innovative techniques such as cardiac catheterization. With the re? ement of the microscope by the Dutch lens maker Anton van Leeuwenhoek (1632–1723), the stage was set for the era of cellular biology. Another early user of the microscope, English scientist Robert Hooke (1635–1703), published his Micrographia in 1665 in which CHAPTER 1 Concepts of Health and Disease 7 William Harvey’s most eminent patient, King Charles I, and the future King Charles II look on as Harvey displays a dissected deer heart. (Courtesy of the National Library of Medicine) he formally described the plant cells in cork and presented his theories of light and combustion and his studies of insect anatomy.His book presented the great potential of the microscope for biologic investigation. In it, he inaugurated the modern biologic usage of the word cell. A century later, German-born botanist Mathias Schleiden (1804–1881) and physiologist Theodor Schwann (1810–1882) observed that animal tissues also were composed of cells. Although Harvey contributed greatly to the understanding of anatomy and physiology, he was not interested in the chemistry of life. It was not until French chemist Antoine Lavoisier (1743–1794), who was schooled as a lawyer but devoted to scienti? pursuits, overturned 100year-old theories of che mistry and established the basis of modern chemistry that new paths to examine body processes, such as metabolism, opened up. His restructured chemistry also gave scientists, including Louis Pasteur, the tools to develop organic chemistry. In 1796, Edward Jenner (1749–1823) conducted the ? rst vaccination by injecting the ? uid from a dairymaid’s cowpox lesion into a young boy’s arm. The vaccination by this English country doctor successfully protected the child from smallpox. Jenner’s discovery led to the development of vaccines to prevent many other diseases as well.Jenner’s classic experiment was the ? rst of? cially recorded vaccination. Painting by Georges-Gaston Melingue (1894). The ? rst vaccination. Here Dr. Jenner introduces cowpox taken from dairymaid Sarah Nelmes (right) and introduces it into two incisions on the arm of James Phipps, a healthy 8-year-old boy. The boy developed cowpox, but not smallpox, when Jenner introduced the organis m into his arm 48 days later. (Courtesy of the National Library of Medicine) THE NINETEENTH CENTURY The nineteenth century was a time of spectacular leaps forward in the understanding of infectious diseases.For many centuries, rival epidemiologic theories associated disease and epidemics like cholera with poisonous fumes given off from dung heaps and decaying matter (poisons in the air, exuded from rotting animal and vegetable material, the soil, and standing water) or with contagion (person-to-person contact). In 1865, English surgeon Joseph Lister (1827–1912) concluded that microbes caused wound infections. He began to use carbolic acid on wounds to kill microbes and reduce infection after surgery. However, Lister was not alone in identifying hazards in the immediate environment as detrimental to health.English nurse Florence Nightingale (1820–1910) was a leading proponent of sanitation and hygiene as weapons against disease. It was at the English base at Scutari dur ing the Crimean War (1854–1856) that Nightingale waged her battle. Arriving at the army hospital with a party of 38 nurses, Nightingale found nearly 2000 wounded and sick inhabiting foul, rat-infested wards. The war raged on, deluging the hospital with wounded as Nightingale not only organized the nursing care of the wounded but also provided meals, supplied bedding, and saw to the laundry.Within 6 months, she had brought about a transformation and slashed the death rate from approximately 40% to 2%. 3 8 UNIT I Concepts of Health and Disease Florence Nightingale caring for wounded at Scutari, Turkey, during the Crimean War. (Courtesy of the National Library of Medicine) From the 1860s, the rise of bacteriology, associated especially with chemist and microbiologist Louis Pasteur in France and bacteriologist Robert Koch in Germany, established the role of microorganismal pathogens. Almost for the ? rst time in medicine, bacteriology led directly to dramatic new cures.The techni que of pasteurization is named after Louis Pasteur (1822–1895). He introduced the method in 1865 to prevent the souring of wine. Pasteur’s studies of fermentation convinced him that it depended on the presence of microscopic forms of life, with each fermenting medium serving as a unique food for a speci? c microorganism. He developed techniques for culturing microbes in liquid broths. Through his work, he was able to dispel the disease theory that predominated in the mid-nineteenth century, attributing fevers to â€Å"miasmas,† or fumes, and laid the foundation for the germ theory of disease.The anthrax bacillus, discovered by Robert Koch (1843–1910), was the ? rst microorganism identi? ed as a cause of illness. Koch’s trailblazing work also included identifying the organism responsible for tuberculosis and the discovery of a tuberculosis skin-testing material. In 1895, German physicist Wilhelm Rontgen (1845– 1923) discovered X rays. For the ? rst time without a catastrophic event, the most hidden parts of a human body were revealed. Even though he understood that it was a signi? cant discovery, Rontgen did not initially recognize the amazing diagnostic potential of the process he had discovered.THE TWENTIETH CENTURY The twentieth century was a period of revolutionary industry in the science and politics of health. Concerns about the care of infants and children and the spread of infectious disease became prevailing themes in public and political arenas alike. It was during this time that private duty and public health nursing emerged as the means of delivering health care to people in their homes and in their communities. Social service agencies like the Henry Street Settlement in New York, founded by Lillian Wald, sent nurses into tenements to care for the sick. The placement of nurses in schools began in New York City in 1902 at the urging of Wald, who offered to supply a Henry Street nurse for 1 month without charg e. 5 Efforts to broaden the delivery of health care from the city to rural areas also were initiated during the early 1900s. The American Red Cross, which was reorganized and granted a new charter by Congress in 1905, established a nursing service for the rural poor that eventually expanded to serve the small town poor as well. 5 Scienti? c discoveries and innovations abounded in the twentieth century.In the early 1900s, German bacteriologist Paul Ehrlich (1854–1915) theorized that certain substances could act as â€Å"magic bullets,† attacking disease-causing microbes but leaving the rest of the body undamaged. In 1910, he introduced his discovery: using the arsenic compound Salvarsan, he had found an effective weapon against syphilis. Through his work, Ehrlich launched the science of chemotherapy. CHAPTER 1 Concepts of Health and Disease 9 The operating room. With the advent of anesthesia, knowledge of how microbes cause disease, and availability of incandescent ligh ting in the operating room, surgery became an option for treating disease.Rubber gloves had not yet been invented and the surgical team worked with bare hands to perform surgery. (Hahnemann Hospital, Chicago, IL. Courtesy Bette Clemons, Phoenix, AZ) The ? rst antibiotic was discovered in 1928 by English bacteriologist Sir Alexander Fleming (1881–1955). As he studied the relationship between bacteria and the mold Penicillium, he discovered its ability to kill staphylococci. However, it was not until the 1940s that later researchers, who were searching for substances produced by one microorganism that might kill other microorganisms, produced penicillin as a clinically useful antibiotic.By the 1930s, innovative researchers had produced a cornucopia of new drugs that could be used to treat many of the most common illnesses that left their victims either severely disabled or dead. The medical community now had at its disposal medications such as digoxin to treat heart failure; su lfa drugs, which produced near-miraculous cures for infections such as scarlet fever; and insulin to treat diabetes. At the turn of the century, social service agencies like Henry Street Settlement in New York sent nurses into tenements to care for the sick. (Schorr T. M. , Kennedy S.M. [1999]. 100 years of American nursing [p. 12]. Philadelphia: Lippincott Williams & Wilkins) 10 UNIT I Concepts of Health and Disease With the discovery of insulin, a once-fatal disease known from antiquity no longer carried a death sentence. Working together, Canadian physician Sir Frederick Banting (1891–1941) and physiologist Charles Best (1899–1978) isolated insulin from the pancreas of a dog in 1921. The extract, when given to diabetic dogs, restored their health. In January 1922, they successfully treated a young boy dying of diabetes with their pancreatic extracts.Although still incurable, it became possible to live with diabetes. One disease that remained not only incurable but u ntreatable through much of the twentieth century was tuberculosis. With no cure or preventive vaccine forthcoming, efforts at the turn of the century were dedicated to controlling the spread of tuberculosis. It was then that an alliance between organized medicine and the public resulted in the formation of voluntary local organizations to battle the disease. These organizations focused on education to counteract the fear of tuberculosis; at the same time, they warned against the disease.In 1904, the local organizations joined together to form a national organization, the National Association for the Study and Prevention of Tuberculosis. In 1918, the name was changed to the National Tuberculosis Association, which was renamed the American Lung Association in 1973. 6 The national and local tuberculosis associations played a vital role in educating the public by running campaigns urging people to have skin tests and chest x-rays as a means of diagnosing tuberculosis. Once tuberculosis was diagnosed, an individual was likely to be sent to a sanatorium or tuberculosis hospital.There, good nourishment, fresh air, and bed rest were prescribed in the belief that if the body’s natural defenses were strengthened, they would be able to overcome the tuberculosis bacillus. For almost half a century, this would be the prevailing treatment. It was not until 1945, with the introduction of chemotherapy, that streptomycin was used to treat tuberculosis. Outbreaks of poliomyelitis, which had increased in the early decades of the 1900s, served as the impetus for the work of American microbiologist Jonas Salk (1914–1995).At its peak, the virus was claiming 50,000 victims annually in the United States. 3 Test trials of Salk’s vaccine with inactivated virus began in 1953, and it proved to prevent the development of polio. By 1955, the massive testing was complete, and the vaccine was quickly put into wide use. Surgical techniques also flourished during this time . A single technical innovation was responsible for opening up the last surgical frontier—the heart. Up to this time, the heart had been out of bounds; surgeons did not have the means to take over the function of the heart for long enough to get inside and operate. American surgeon John Gibbon (1903–1973) addressed this problem when he developed the heart-lung machine. Dramatic advances followed its successful use in 1953—probably none more so than the ? rst successful heart transplantation performed in 1967 by South African surgeon Christiaan Barnard (1922–2001). For centuries, the inheritance of traits had been explained in religious or philosophical terms. Although English naturalist Charles Darwin’s (1809–1882) work dispelled long-held beliefs about inherited traits, it was Austrian bo-A tuberculosis skin testing clinic. (Schorr T. M. , Kennedy S. M. [1999]. 100 years of American nursing [p. 49]. Philadelphia: Lippincott Williams & Wilki ns) CHAPTER 1 Concepts of Health and Disease 11 The â€Å"iron lung,† which used negative pressure to draw air into the lungs, was used to provide ventilatory support for persons with â€Å"bulbar polio. † (Schorr T. M. , Kennedy S. M. [1999]. 100 years of American nursing [p. 91]. Philadelphia: Lippincott Williams & Wilkins) anist Gregor Mendel’s (1822–1884) revolutionary theories on the segregation of traits, largely ignored until 1902, that laid the groundwork for establishing the chromosome as the structural unit of heredity. Many other scientists and researchers contributed to the storehouse of genetic knowledge. With the work by American geneticist James Watson (1928–) and British biophysicists Francis Crick (1916–) and Maurice Wilkins (1916–) in the early 1950s, which established the double-helical structure of DNA, the way to investigating and understanding our genetic heritage was opened.It is dif? cult, if not impossible, to single out all the landmark events of the twentieth century that contributed to the health of humankind. Among the other notable achievements are the development of kidney dialysis, oral contraceptives, transplant surgery, the computed axial tomography (CAT) scanner, and coronary angioplasty. Not all of the important advances in modern medicine are as dramatic as open-heart surgery. Often, they are the result of dogged work by many people and yield results only after a number of years, and then they frequently go unheralded.For example, vaccination programs, control of infectious diseases through improvements in sanitation of water and waste disposal, safer and healthier foods free from microbial contamination, identi? cation of health risks from behaviors such as smoking, and improved prenatal care all have saved many lives in the twentieth century. THE TWENTY-FIRST CENTURY The twenty-? rst century reveals new horizons, but also new problems. In greater numbers than ever, goods an d people travel the world. There is unprecedented physical mobility—travel and migration from villages to cities and country to country—and interconnectedness.However, the bene? ts of physical mobility and interconnectedness are accompanied by risks. Diseases such as AIDS remind us that nothing is regional, local, or limited in its reach: contagious illness has a worldwide arena. The challenges of maintaining health and well-being in this global community are increasingly apparent. The inadvertent introduction of pathogens poses an unrelenting threat to public health, as does the deliberate use of microorganisms as weapons (see Chapter 18 for a discussion of bioterrorism and emerging global infectious diseases).In February 2003, the viral respiratory illness named severe acute respiratory syndrome (SARS) by the World Health Organization was ? rst recognized in China. 8 In the next few months, the illness swept through parts of Asia and spread to more than two dozen cou ntries in North America, South America, and Europe. The disease was characterized by rapid onset and variable severity, ranging from mild illness to death. The prevention of SARS was a particular challenge because preventive interventions (e. g. , vaccines and antibiotics) were unavailable.Containment became a global collaboration, with public health authorities utilizing isolation and quarantine to focus delivery of health care to people who were ill and to protect healthy people from getting sick. During the February to July outbreak, more than 8000 people worldwide became infected, and more than 900 died. Commerce also is an integral part of the growing world community, bringing goods and services once unobtainable into the global marketplace. Expanded international trade also provides the vehicle for the unwitting introduction or transmission of disease. One such instance occurred in the spring of 2003 in the United States. A multistate outbreak of human monkeypox, ? rst identi? ed in the Democratic Republic of the Congo in 1970, was traced by investigators to pet prairie dogs. The prairie dogs became infected when they were housed or transported along with infected Gambian giant rats, dormice, and rope squirrels that were part of a shipment of small mammals from Ghana. Spread of nonindigenous zoonotic pathogens to indigenous susceptible animal populations can be rapid and deadly. With such outbreaks lurks an additional danger—the potential for interspecies exchange, including between humans and animals such as pets.The widespread distribution of infected and potentially infected animals allowed epizootic spread of monkeypox through several states before effective interventions could be put into place. One of the challenges to the world health community will be to study the role of international travel and commerce in the emergence of infectious diseases through the dissemination of pathogens and their vectors throughout the world and then to develo p long-term strategies of surveillance and intervention with the ultimate goal of curtailing their occurrence.In 1976, the World Health Organization (WHO) actually succeeded in eliminating smallpox from the face of the earth. 10 This triumph gave substance to the idea that other infections, like measles, also might disappear if suf? cient efforts were directed at worldwide campaigns to isolate and cure them. However, new infectious diseases, such as Lyme disease and Legionnaire’s disease, and new forms of old diseases, such as resistant strains of tuberculosis and malaria, have emerged and are readily spread 12 UNIT I Concepts of Health and Disease ing on Hippocratic doctrines and introducing experimentation into the study of healing.His work, gleaned through his role as physician to the emperors and gladiators of Rome and animal dissections, came to be regarded as the encyclopedia of anatomy and physiology and was considered infallible for almost 1400 years. Signi? cant chal lenges to long-held beliefs began with the work of Andreas Vesalius (1514–1564), professor of anatomy and surgery at Padua, Italy. His published work, On the Fabric [Structure] of the Human Body, showing how the parts of the body looked and worked, set a new standard for the understanding of human anatomy.Other significant early contributions were made by scholars such as William Harvey (1578–1657), the English physician and physiologist, who in his book, On the Motion of the Heart and Blood in Animals, provided a physiologic framework for the circulation of blood; Anton van Leeuwenhoek (1632–1723), the Dutch lens maker who refined the microscope and set the stage for the era of cellular biology; and Edward Jenner (1749–1823), the English country physician who conducted the first successful vaccination. The nineteenth century was a time of major discoveries that paved the way for understanding infectious diseases.Signi? cant contributions were made by suc h scientists as Joseph Lister, the English surgeon who concluded that microbes caused wound infections; German bacteriologist Robert Koch, who discovered the anthrax bacillus, thus identifying for the ? rst time a microorganism and the illness it caused; and French chemist and microbiologist Louis Pasteur, who developed the technique of pasteurization. Perhaps the most notable technical innovation of the century was the discovery of X rays by German physicist Wilhelm Rontgen. The scienti? undertakings and discoveries of the twentieth century were revolutionary. In 1910, Paul Ehrlich introduced chemotherapy, and in 1928, Sir Alexander Fleming discovered the ? rst antibiotic as he studied the relationship between bacteria and the mold Penicillium. Diseases that had once been fatal or crippling were managed or prevented by new advances, such as the discovery of insulin by Sir Frederick Banting and Charles Best in 1922 and the development of the polio vaccine by Jonas Salk in 1953. Tech nical innovations set the stage for new surgical techniques.The creation of the heartlung machine by American surgeon John Gibbon paved the way for coronary bypass surgery and the ? rst successful heart transplantation in 1967, which was performed by Christiaan Barnard, a South African surgeon. Other important advances included kidney dialysis, oral contraceptives, the CAT scanner, and coronary angioplasty. Public health programs also were responsible for greatly affecting the health of populations, such as those dedicated to increasing vaccination, improving sanitation of water and waste disposal, and identifying health risks.Knowledge about the in? uence of heredity on health and disease originated with Charles Darwin’s (1809–1882) evolutionary theories about inherited traits and with Gregor Mendel’s (1822–1884) theories on the segregation of traits, which laid the groundwork for establishing the chromosome as the structural unit of heredity. In the ear ly 1950s, geneticist James Watson of the United States and British biophysicists Francis Crick and Maurice Wilkins presented their ? ndings on the double-helical structure of DNA. worldwide.The powerful interventions used to ? ght these infections have had the unexpected effect of accelerating their biologic evolution and making them impervious to one after another form of chemical attack. Pathogens also can be introduced into the food chain and travel worldwide. The discovery that beef from cattle infected with bovine spongiform encephalopathy (BSE) may be the source of Creutzfeldt-Jakob disease led many countries to ban beef products from the United Kingdom when BSE was found to be prevalent in English herds.The introduction of such pathogens can be the result of ignorance, carelessness, or greed. Tobacco is a product that serves as a pathogen. In a quest for ever-increasing pro? ts, the tobacco industry created a demand for its product by arti? cially raising the nicotine content of cigarettes so as to increase their addictive potential. This was done with the knowledge of the health risks of tobacco products, thanks to experiments conducted by the tobacco companies’ own medical scientists, but kept secret.If there is a blueprint for future advances, it is in the genes. The twenty-? rst century is destined to be dominated by advances in genetics. With the mapping of the human genome comes hope of cure for some of the most dreaded crippling and fatal diseases. The mapping of the human genome also has posed new ethical dilemmas, for with it comes the potential to predict the future health of persons based on their genes. It soon may be possible to differentiate between persons who will develop certain debilitating diseases and those who will not.Although advances in science and technology will continue to provide new treatments for many diseases, it has become apparent that there are more impressive rewards to be had by preventing diseases from becomin g established in the ? rst place. Ultimately, maintaining health is more resource conservative and cost effective than relying on the treatment of disease. Many decades ago, we learned that even though the â€Å"magic bullets† such as antibiotics had the ability to cure what was once considered incurable, much of our freedom from communicable disease is due to clean water, ef? ient sanitation, and good nutrition. We have become increasingly aware of the importance of preventive measures against noninfectious conditions, especially cancer and coronary heart disease. There is no better way to prevent disease and maintain health than by leading a healthy life, and increasingly, it will be the individual who is responsible for ensuring a healthy passage through life. In summary, Greek scholars were responsible for establishing the fundamentals of anatomy, physiology, and pathology that served as the earliest knowledge base for understanding health and disease.It was Hippocrates ( 460–377 BC) and his followers who laid the foundations of the clinical principles and ethics that grew into modern science. Although his belief that disease occurred when the four humors—blood, yellow and black bile, and phlegm—became out of balance was disproved, his approach to health that dictated plenty of healthy exercise, rest in illness, and a moderate, sober diet remains valid. Galen (AD 129–199) took the next major step, expand- CHAPTER 1 The twenty-? rst century is predicted to be a time of great advances in the ? ld of genetics, already evidenced by the substantial mapping of the human genome that has taken place. Scientists look to genetic research to provide advances that not only will predict who may develop disease but also will provide new treatments for those diseases. However promising future advances may appear, it is readily apparent that prevention is an equally important tool in maintaining health. Concepts of Health and Disease 13 P erspectives on Health and Disease in IndividualsAfter completing this section of the chapter, you should be able to meet the following objectives: ? State the World Health Organization de? nition of health ? Describe the function of adaptation as it relates to health and disease ? State a de? nition of pathophysiology ? Characterize the disease process in terms of etiology, pathogenesis, morphology, clinical manifestations, and prognosis ? Explain the meanings of reliability, validity, sensitivity, speci? city, and predictive value as they relate to observations and tests used in the diagnosis of diseaseWhat constitutes health and disease often is dif? cult to determine because of the way different people view the topic. What is de? ned as health is determined by many factors, including heredity, age and sex, cultural and ethnic differences, as well as individual, group, and governmental expectations. HEALTH The World Health Organization (WHO) in 1948 de? ned health as a â€Å"stat e of complete physical, mental, and social well-being and not merely the absence of disease and in? rmity. †10 Although ideal for many people, this was an unrealistic goal.At the World Health Assembly in 1977, representatives of the member governments of WHO agreed that their goal was to have all citizens of the world reach a level of health by the year 2000 that allows them to live a socially and economically productive life. 10 The U. S. Department of Health and Human Services in Healthy People 2010 described the determinants of health as an interaction between an individual’s biology and behavior, physical and social environments, government policies and interventions, and access to quality health care. 1 with which the need to adapt occurs (see Chapter 9). Generally speaking, adaptation affects the whole person. When adapting to stresses that are threats to health, the body uses those behaviors that are the most ef? cient and effective. It does not use long-term mec hanisms when short-term adaptation is suf? cient. The increase in heart rate that accompanies a febrile illness is a temporary response designed to deliver additional oxygen to tissues during the short period that the elevated temperature increases metabolic needs.On the other hand, hypertrophy of the left ventricle is a long-term adaptive response that occurs in persons with chronic hypertension. Adaptation is further affected by the availability of adaptive responses and the ability of the body to select the most appropriate response. The ability to adapt is dependent on the availability of adaptive responses—the greater number of available responses, the more effective the capacity to adapt. Adaptive capacity is decreased with extremes of age and with disease conditions that limit the availability of adaptive responses.The immaturity of the infant impairs the ability to adapt, as does the decline in functional reserve that occurs in the elderly. For example, infants have d if? culty concentrating urine because of the immaturity of their renal tubular structures and therefore are less able than an older child or adult to cope with decreased water intake or exaggerated water losses. Similarly, persons with preexisting heart disease are less able to adapt to health problems that require recruitment of cardiovascular responses. Adaptation also is less effective when changes in health status occur suddenly rather than gradually.For instance, it is possible to lose a liter of blood through chronic gastrointestinal bleeding without developing signs of shock. On the other hand, a sudden hemorrhage that causes the loss of an equal amount of blood is apt to produce hypotension and circulatory shock. Even in advanced disease states, the body retains much of its adaptive capacity and is able to maintain the internal environment within relatively normal limits. DISEASE The term pathophysiology, which is the focus of this book, may be de? ned as the physiology of a ltered health. The term combines the words pathology and physiology.Pathology (from the Greek pathos, meaning â€Å"disease†) deals with the study of the structural and functional changes in cells, tissues, and organs of the body that cause or are caused by disease. Physiology deals with the functions of the human body. Thus, pathophysiology deals not only with the cellular and organ changes that occur with disease but also with the effects that these changes have on total body function. Pathophysiology also focuses on the mechanisms of the underlying disease and provides the background for preventive as well as therapeutic health care measures and practices.A disease has been de? ned as any deviation from or interruption of the normal structure or function of a part, organ, or system of the body that is manifested by a characteristic set of symptoms or signs; the etiology, pathology, and prognosis may be known or unknown. 12 The aspects HEALTH AND DISEASE AS STATES OF ADAPTA TION The ability of the body to adapt both physically and psychologically to the many stresses that occur in both health and disease is affected by a number of factors, including age, health status, psychosocial resources, and the rapidity 14 UNIT I Concepts of Health and Disease f the disease process include the etiology, pathogenesis, morphologic changes, clinical manifestations, diagnosis, and clinical course. ity, the progression from fatty streak to the occlusive vessel lesion seen in persons with coronary heart disease represents the pathogenesis of the disorder. The true etiology of atherosclerosis remains largely uncertain. Etiology The causes of disease are known as etiologic factors. Among the recognized etiologic agents are biologic agents (e. g. , bacteria, viruses), physical forces (e. g. , trauma, burns, radiation), chemical agents (e. g. , poisons, alcohol), and nutritional excesses or de? its. At the molecular level, it is important to distinguish between sick molecu les and molecules that cause disease. 13 This is true of diseases such as cystic ? brosis, sickle cell anemia, and familial hypercholesterolemia, in which genetic abnormality of a single amino acid, transporter molecule, or receptor protein produces widespread effects on health. Most disease-causing agents are nonspeci? c, and many different agents can cause disease of a single organ. For example, lung disease can result from trauma, infection, exposure to physical and chemical agents, or neoplasia.With severe lung involvement, each of these agents has the potential to cause respiratory failure. On the other hand, a single agent or traumatic event can lead to disease of a number of organs or systems. For example, severe circulatory shock can cause multiorgan failure. Although a disease agent can affect more than a single organ, and a number of disease agents can affect the same organ, most disease states do not have a single cause. Instead, most diseases are multifactorial in origin . This is particularly true of diseases such as cancer, heart disease, and diabetes.The multiple factors that predispose to a particular disease often are referred to as risk factors. One way to view the factors that cause disease is to group them into categories according to whether they were present at birth or acquired later in life. Congenital conditions are defects that are present at birth, although they may not be evident until later in life. Congenital malformation may be caused by genetic in? uences, environmental factors (e. g. , viral infections in the mother, maternal drug use, irradiation, or intrauterine crowding), or a combination of genetic and environmental factors.Not all genetic disorders are evident at birth. Many genetic disorders, such as familial hypercholesterolemia and polycystic kidney disease, take years to develop. Acquired defects are those that are caused by events that occur after birth. These include injury, exposure to infectious agents, inadequate n utrition, lack of oxygen, inappropriate immune responses, and neoplasia. Many diseases are thought to be the result of a genetic predisposition and an environmental event or events that serve as a trigger to initiate disease development. MorphologyMorphology refers to the fundamental structure or form of cells or tissues. Morphologic changes are concerned with both the gross anatomic and microscopic changes that are characteristic of a disease. Histology deals with the study of the cells and extracellular matrix of body tissues. The most common method used in the study of tissues is the preparation of histologic sections that can be studied with the aid of a microscope. Because tissues and organs usually are too thick to be examined under a microscope, they must be sectioned to obtain thin, translucent sections.Histologic sections play an important role in the diagnosis of many types of cancer. A lesion represents a pathologic or traumatic discontinuity of a body organ or tissue. De scriptions of lesion size and characteristics often can be obtained through the use of radiographs, ultrasonography, and other imaging methods. Lesions also may be sampled by biopsy and the tissue samples subjected to histologic study. Clinical Manifestations Disease can be manifest in a number of ways. Sometimes, the condition produces manifestations, such as fever, that make it evident that the person is sick.Other diseases are silent at the onset and are detected during examination for other purposes or after the disease is far advanced. Signs and symptoms are terms used to describe the structural and functional changes that accompany a disease. A symptom is a subjective complaint that is noted by the person with a disorder, whereas a sign is a manifestation that is noted by an observer. Pain, dif? culty in breathing, and dizziness are symptoms of a disease. An elevated temperature, a swollen extremity, and changes in pupil size are objective signs that can be observed by someone other than the person with the disease.Signs and symptoms may be related to the primary disorder, or they may represent the body’s attempt to compensate for the altered function caused by the pathologic condition. Many pathologic states are not observed directly—one cannot see a sick heart or a failing kidney. Instead, what can be observed is the body’s attempt to compensate for changes in function brought about by the disease, such as the tachycardia that accompanies blood loss or the increased respiratory rate that occurs with pneumonia. It is important to recognize that a single sign or symptom may be associated with a number of different disease states.For example, an elevated temperature can indicate the presence of an infection, heat stroke, brain tumor, or any number of other disorders. A differential diagnosis that describes the origin of a disorder usually requires information regarding a number of signs and symptoms. For example, the presence of fever , a reddened sore throat, and positive throat culture describe a â€Å"strep throat† infection. A syndrome is a compilation of signs and symptoms (e. g. , chronic fatigue syndrome) that are characteristic of a speci? c disease state. Complications are possible adverse ex-Pathogenesis Pathogenesis is the sequence of cellular and tissue events that take place from the time of initial contact with an etiologic agent until the ultimate expression of a disease. Etiology describes what sets the disease process in motion, and pathogenesis, how the disease process evolves. Although the two terms often are used interchangeably, their meanings are quite different. For example, atherosclerosis often is cited as the cause or etiology of coronary heart disease. In real- CHAPTER 1 Concepts of Health and Disease 15 ensions of a disease or outcomes from treatment. Sequelae are lesions or impairments that follow or are caused by a disease. Diagnosis A diagnosis is the designation as to the na ture or cause of a health problem (e. g. , bacterial pneumonia or hemorrhagic stroke). The diagnostic process usually requires a careful history and physical examination. The history is used to obtain a person’s account of his or her symptoms, their progression, and the factors that contribute to a diagnosis. The physical examination is done to observe for signs of altered body structure or function.The development of a diagnosis involves weighing competing possibilities and selecting the most likely one from among the conditions that might be responsible for the person’s clinical presentation. The clinical probability of a given disease in a person of a given age, sex, race, lifestyle, and locality often is in? uential in arriving at a presumptive diagnosis. Laboratory tests, radiologic studies, CT scans, and other tests often are used to con? rm a diagnosis. Normality. An important factor when interpreting diagnostic test results is the determination of whether they are normal or abnormal.Is a blood count above normal, within the normal range, or below normal? Normality usually determines whether further tests are needed or if interventions are necessary. What is termed a normal value for a laboratory test is established statistically from test results obtained from a selected sample of people. The normal values refer to the 95% distribution (mean plus or minus two standard deviations [mean  ± 2 SD]) of test results for the reference population. 14 Thus, the normal levels for serum sodium (135 to 145 mEq/L) represent the mean serum level for the reference population  ± 2 SD.The normal values for some laboratory tests are adjusted for sex or age. For example, the normal hemoglobin range for women is 12. 0 to 16. 0 g/dL and for men, 14. 0 to 17. 4 g/dL. 15 Serum creatinine level often is adjusted for age in the elderly (see Chapter 36), and normal values for serum phosphate differ between adults and children. Reliability, Validity, Sensitivit y, Speci? city, and Predictive Value. The quality of data on which a diagnosis is based may be judged for its reliability, validity, sensitivity, speci? city, and predictive value. 6,17 Reliability refers to the extent to which an observation, if repeated, gives the same result. A poorly calibrated blood pressure machine may give inconsistent measurements of blood pressure, particularly of pressures in either the high or low range. Reliability also depends on the persons making the measurements. For example, blood pressure measurements may vary from one observer to another because of the technique that is used (e. g. , different observers may de? ate the cuff at a different rate, thus obtaining different values), the way the numbers on the manometer are read, or differences in hearing acuity.Validity refers to the extent to which a measurement tool measures what it is intended to measure. This often is assessed by comparing a measurement method with the best possible method of measu re that is available. For example, the validity of blood pressure measurements ob- tained by a sphygmomanometer might be compared with those obtained by intraarterial measurements. Measures of sensitivity and speci? city are concerned with determining how well the test or observation identi? es people with the disease and people without the disease.Sensitivity refers to the proportion of people with a disease who are positive for that disease on a given test or observation (called a true-positive result). Speci? city refers to the proportion of people without the disease who are negative on a given test or observation (called a true-negative result). A test that is 95% speci? c correctly identi? es 95 of 100 normal people. The other 5% are false-positive results. A false-positive test result, particularly for conditions such as human immunodeficiency virus (HIV) infection, can be unduly stressful for the person being tested (see Chapter 22).In the case of HIV testing, a positive res ult on the initial antibody test is followed up with a more sensitive test. On the other hand, false-negative test results in conditions such as cancer can delay diagnosis and jeopardize the outcome of treatment. Predictive value is the extent to which an observation or test result is able to predict the presence of a given disease or condition. A positive predictive value refers to the proportion of true-positive results that occurs in a given population.In a group of women found to have â€Å"suspect breast nodules† in a cancer-screening program, the proportion later determined to have breast cancer would constitute the positive predictive value. A negative predictive value refers to the true-negative observations in a population. In a screening test for breast cancer, the negative predictive value represents the proportion of women without suspect nodules who do not have breast cancer. Although predictive values rely in part on sensitivity and speci? city, they depend more heavily on the prevalence of the condition in the population. Despite unchanging sensitivity and speci? ity, the positive predictive value of an observation rises with prevalence, whereas the negative predictive value falls. Clinical Course The clinical course describes the evolution of a disease. A disease can have an acute, subacute, or chronic course. An acute disorder is one that is relatively severe, but selflimiting. Chronic disease implies a continuous, long-term process. A chronic disease can run a continuous course, or it can present with exacerbations (aggravation of symptoms and severity of the disease) and remissions (a period during which there is a lessening of severity and a decrease in symptoms).Subacute disease is intermediate or between acute and chronic: it is not as severe as an acute disease and not as prolonged as a chronic disease. The spectrum of disease severity for infectious diseases such as hepatitis B can range from preclinical to persistent chronic inf ection. During the preclinical stage, the disease is not clinically evident but is destined to progress to clinical disease. As with hepatitis B, it is possible to

Is the american dream achievable? Essay

The American Dream: the image of a white picket fence house with a perfect family, two educated children, one girl and one boy and the mother and father both working without worrying about financials concerns. This is the typical example of the American Dream; it is called the stereotypical dream. The Oxford dictionary states that the American Dream is, â€Å"The traditional social ideals of the US, such as equality, democracy and material prosperity.† However, I firmly believe the American Dream is to be accepted, to be free and to be equal; overall the dream is to pursue personal happiness. I strongly believe that the American Dream was not attainable in the past, is not attainable in the present day and will not be attainable in the future. Immigration is a prime reason why the American Dream is unachievable. I feel that poorer individuals appreciate and make the most of the little things they have and this would suggest that their money worries does not affect their ‘dream’. I also believe, despite the fact they are struggling financially, they still put others before themselves, ensuring their children have the opportunity to lead a ‘better’ life, the chance they themselves never had. Immigrants strive to fit in with the US ‘crowd’ as they don’t want to be seen as different. Immigrants flock to America so that they too can grab a piece of the exciting, spectacular dream that they perceive that America offers. Individuals arrive in the USA expecting every day to be like the fourth of July. The harsh reality is far from it. In 2012, overall crime rates rose to roughly 10.2 million; America ‘the land of opportunity’ is home to nothing but crime. They then realised the world they had stepped into involved a lot of hard work with little rewards as the median household income is $50,502. [3: http://en.wikiquote.org/wiki/American_Dream][4: http://www.disastercenter.com/crime/uscrime.htm][5: http://www.mybudget360.com/how-much-do-americans-earn-what-is-the-average-us-income/] The idea of the American Dream is that a person, no matter their race, class  or background has equal opportunity to succeed as they would stand or fall by their capability and accomplishments. I strongly believe equal opportunity in reality is non-existent as discrimination is widespread in the US. Both sexes compete against one another for power and command in the workplace; however, men are usually seen as the powerful gender as they are given the higher positions. Education is another issue within discrimination- the quality and quantity. Education has a long term impact on an individual as poor educational success impacts directly on employment prospects, poverty and limited ability to contribute to American society. Students from impoverished homes who attend racially segregated schools are often given exposure to the better standards of education and opportunities to forge good social networks, of the type that is usually enjoyed by students in weather predominately white schools. The wealthiest ten percent of US school boards spend almost ten times more than the poorest ten percent, demonstrating that not all schools have equal school resources. Unequal academic opportunities also occur; Blacks and Latino students scoring the same results as whites and Asians are less likely to be placed in fast track courses. I believe this evidence indicates that discrimination still exists in America today. Real equality means not judging a book by its cover, treating it differently because of what may look like or where it came from, none of that is important; it’s about the quality of the story within. For some the American Dream is having a successful job which brings financial security and a comfortable life. However, employment is a major concern in America as a significant number of Americans have given up job hunting or are only working part time. The number of unemployed Americans is currently 22.7 million; 12.3 million are unemployed and want work but have stopped the search, 2.4 million are working part time and 8 million can’t find full time employment. Roughly a quarter of Americans between the ages of eighteen to thirty are still living at home relying on their parents. The majority of Americans are on the brink of poverty because there aren’t enough jobs to go around. I passionately believe the American Dream will only remain a dream since having, or not having, money is a controlling factor. The final, compelling reason to why the American Dream is not achievable is the expensive health care system. America does not have an NHS system as is available to the UK citizens and they must ensure against  possible ill health- many simply can’t afford to do this. Therefore US national lives are in constant threat of increasing cost of health insurance. This is a worrying issue for the US government too; the latest statics from the Centres for Disease Control and Prevention (CDC) found that health care costs in America were around $147 billion to cover health complications from obesity alone. Being obese costs $6,454 per year. In twenty years experts predict that over half of American adults and the majority of children will become super-sized. In conclusion, I passionately believe the American Dream is not achievable due to the four key points which have been explored throughout the context; immigration, lack of equal opportunities, unemployment and health care. The Ame rican Dream emphasises being perfect, but perfection is not humanly possible and neither is this so called dream. Jasmine Chalk [6: http://en.wikipedia.org/wiki/inequality_in_a_workplace#cite_note-Devey-2][7: http://www.aecf.org/upload/publicationfiles/fact_sheet3.pdf][8: http://www.aecf.org/upload/publicationfiles/fact_sheet3.pdf][9: http://www.aecf.org/upload/publicationfiles/fact_sheet3.pdf][10: http://www.rpc.senate.gov/policy-papers/january-2013-unemployment-report][11: Young U.S. Adults Flock to Parents’ Homes Amid EconomyBy Kathy Warbelow & Frank Bass – Sep 25, 2012 5:01 AM GMT http://www.bloomberg.com/news/2012-09-25/young-adults-flock-to-parents-homes-amid-sour-economy.html][12: ‘Real Cost of Living’: Price tag for obesity is $6,454 a yearby Carmen Wong Ulrich (Perigee Trade, 2010) http://www.today.com/id/40844081/ns/today-today_books/t/real-cost-living-price-tag-obesity-year/#.UhZXwpJJOAg][13: ‘Real Cost of Living’: Price tag for obesity is $6,454 a yearby Carmen Wong Ulrich (Perigee Trade, 2010)http://www.today.com/id/40844081/ns/today-today_boo ks/t/real-cost-living-price-tag-obesity-year/#.UhZXwpJJOAg][14: ‘Real Cost of Living’: Price tag for obesity is $6,454 a yearby Carmen Wong Ulrich (Perigee Trade, 2010)http://www.today.com/id/40844081/ns/today-today_books/t/real-cost-living-price-tag-obesity-year/#.UhZXwpJJOAg]

Strategic Resources and Firm Performance Executive Summary - Free Essay Example

Sample details Pages: 7 Words: 2190 Downloads: 6 Date added: 2017/06/26 Category Management Essay Type Analytical essay Did you like this example? Overtime, resources become very important for the continuation of a company to achieve competitive advantage. Thus, this essay was assigned to examine the relationship between resource-based view and firms performance especially in achieving sustainable competitive advantage. Along this essay there are some merits and demerits of RBV in achieving competitive advantage. Don’t waste time! Our writers will create an original "Strategic Resources and Firm Performance Executive Summary" essay for you Create order Furthermore, this essay explained about the strengths and weaknesses of RBV in order to achieve competitive advantage and create value to its customers. Further evaluation of RBV model has provided firms with strategic resource, processes, capabilities and the ability to appropriate rent from the resources. While RBV argued firms key resources is the essential elements to attain sustainable competitive advantage, another theory which known as Industry Analysis argued that the key element to achieve sustainable competitive advantage is the firms activities that is performed. Both theories have come with certain strengths and weaknesses. An evaluation suggest that RBV has relationship with firms performance in achieving sustainable competitive advantage and also RBV model is better than Porters analysis because it has less complexity to formulate and implement the strategies. Introduction In recent years, many industries are struggling to take advantage of their resources in order to achieve competitive advantage and improve their performance among their competitors. This approach has forced the managers to understand heterogeneous firm performance and explaining the attributes that render a resource rent-generating (Zubac et al., 2010). To achieve competitive advantage managers have to understand the core of resource-based view (RBV). The term RBV was originally coined by Wernefelt in 1984 (Fahy, 2000), but the RBVs derives from the work of Penrose, who depicted a firm as a collection of productive resources the disposal of which between different uses and over time is determined by administrative decision (Zubac et al., 2010). The basic principle of the RBV is the intercourse between, competitive advantage, superior performance and customer value and the RBV contends that to achieve an SCA the answer lies in the several key resources for which a company has. Altho ugh the RBV has the relationship with firms performance especially in achieving a sustainable competitive advantage, it does not provide a strong relationship in achieving sustainable competitive advantage. Merits and Demerits of the Resource-Based View (RBV) As mentioned above that firms vying to achieve a SCA, competitive advantage is an advantage which is owned by a firm in a given industry or market and is not owned by other firms. The positions of advantage are usually considered as being either lower delivered cost or differentiation or both and the location of advantage is in the marketplace (Fahy, 2000). If a firm enables to achieve a sustainable competitive advantage it enables the firm to gain economic rents. However, sustainability does not mention to a specific period of time, but it relies on the level of competitive duplication. For example, in financial service industries competitive moves are rapidly imitated and sustainable advantages are difficult to achieve. One of the merits of RBV is to give a firm with a sustained competitive advantage by highlighting the firm as a unique collection of resources. A unique collection of resources must meet four conditions, namely, rareness, value, non-substitutability and inimitabil ity. As mentioned before that capabilities and resources are source of competitive advantage, but both do not need fully impart to competitive advantage. In order to impart to CA, both capabilities and resources must impart to present the products and service for which customers are deign to finance at a profitable price (Ortega et al., 2010). The competitive advantage gained by these resources is reflected in superior performance such as higher profits and increase in market share. Second advantage is RBV can be used in underperforming firms to determine resources that are missing, after that evaluate if these resources can be imitate or substitute. Resources such as intangible assets and capabilities are difficult to imitate or duplicate, because it is due to causal ambiguity and firms can utilise their value by employing them in-house, selling or leasing them. However, tangible assets while important to the firm, were identified not to suit the consept key resources due to be cau sally explicit and hence duplicable (Clulow and Gerstman, 2007). Another merit is RBV can be used to distinguish between the different types of capabilities which a firm can own. Finally, RBV caused the firms internal organisation, the producing rental properties of a firms resources and managers resource deployment decision a critical subject for research. Besides, having the advantages to provide sustainable competitive advantage RBV also has some disadvantages. First, despite RBV spotlights the firms as a unique gathering of resources, however, the theory stresses that not everything of these resources has the potential to assign the firm with an SCA (Clulow and Gerstman, 2007). It can be seen that tangible assets were not counted as key resources. Second, according to Zubac et al. (2010) although the proprietary of dynamic capabilities can explicate why several firms enable to surpass their competitors in the long run, it does not tell about the ability to successfully divers ity for the firms in the new markets. Another problem with examining the RBV is that it can be challenging to determine a generally acceptable way to specify the variant resources that be able to constitute a firm, implied in those resources that can influence the firms action and which can be employed in various ways. Finally, while the firms resources contribute to positive performance, RBV has an understanding that the fundamental value of a resource is only important to interpret as inimitability, rareness or an incapability to replace. Strategic Resources, Processes and Capabilities As RBV can differentiate the different kinds of capabilities, it can explain the concept of dynamic capability of why some firms are capable to surpass their competitors in the long run and make significant change in the marketplace. According to Zubac et al. (2010) there are two kinds of capabilities first is Operational capabilities and the second one is dynamic capabilities. Operational capabilities refer to the firms ability to assemble, deploy and combine the firms asset using pre-determined processes, protocol, activities, routines and competence of its employees to create products and services that could be the source of possible profits to its customers. On the other hand, dynamic capabilities refer to those developments at the firm that enable the firm to switch its resource according to certain processes to fulfil various strategic and competitive disputes (Zubac et al. 2010). According to its hierarchy of capabilities, dynamic capabilities are considered to be higher com pare to operational capabilities because it can make a living for a firm in the short run by enabling them to produce, promote and deliver its products and services to the target market. The dynamic capabilities are very essential for firms to outperform and maintain their competitive advantage over other others because, dynamic capabilities are responsible for shifting the focus from materials placed at the firm to those that embodies the knowledge and skills needed to build competences and create value. The core to obtaining a competitive advantage is the utilisation of a valuable resource-capability mixture (Ortega et al. 2010). Resources can lead to a competitive advantage but this in turn defines what a valuable resource is. A resource is said to be useful will depend on the surrounding structure of an organisation such as on the nature of the resource itself. According to the resource-based view, RBV defines how key resources create value to its customers, thus, achieves co mpetitive advantage. In the figure below, it shows that the arrow linking value with sustainable competitive advantage acquires attention to the presumption in the theory that value from a firms dispersion of key resources accords with a customers assessment of value. Source: Clulow and Gerstman, 2007 Figure 1 The relation in the RBV model betwixt the value of main resources and the firms achievement of an SCA may be explained by an understanding of how customers make value evaluation. Understanding which resources customers value would benefit the firm to concentrate to those assets to attain their sustained competitive advantage. Other than that, firms must also consider strategic resources as one of essential part in achieving sustainable competitive advantage. Strategic resources are potential resources to achieve sustainable competitive advantage and if the firm uses RBV to control of strategic resources, it enables the firm to attain profitable position. Strengths and Weaknesses of the RBV and Value Creation In the contribution to firm-level value creation and achieving competitive advantage, RBV has offered some strengths and weaknesses. According to Fahy (2000) the resource-based view have the capability to sustain the conversation within strategic management and between branches of economics and strategic management, creating a mainstay foundation on which to develop advance research. However, the development of RBV requires a number of empirical issues and key conceptual. In a study of cholesterol lowering drug (Zubac et al. 2010); RBV has been enabled to create customer value by utilising the use of technology and employ complementary assets, which covered its capacity to elevate its marketing, reputation and distribution channel management skills. However, the discussion did not explain how the value determined by management to the firms success might be tied to the expansion of the firms customer-centric resources. In order for manager to produce value to its customer by util ising the resources, managers need to figure ways out to interpret and design its different dimension contrary to those firms specific resources that could bring a maximum product and service mix to the target market. Thus, the RBV model has provided managers with clear explanation to mapping its resources so that can present the best product and service to the customers. Source: Zubac et al. 2010 Figure 2 Although managers can use this model to mapping its resources, managers are still highly required to understand the timeframes for delivering and the different product and service-based dimension that are very important to the customers. Furthermore, according to Zubac et al. (2010) there are three suggestions that managers should invariably consider about; first, the attributes which are inveterate in or customers may relate with the industrys products and services. Second, the consistency attained by customers while utilising or being given with the firms products and serv ices. And the third is the purposes and goals which are attained after customers utilise or have been given with its products and services. By seeing firms resources from the RBV as one of the factor to achieve sustainable competitive advantage, it offers difficulty to employ the RBV in a perspective form due to equilibrium orientation. Economic equilibrium is a very beneficial tool, because it provides arrangement to analysis by enabling some and no other outcomes. Porters Industry Analysis vs. RBV However, in the early 1980s (Fahy, 2000) Porter came with the theory of industry analysis to gain competitive advantage and achieve superior positions. As compared to RBV, the industry analysis argued that firms were not paid for products per se, but rather reimbursed for the activities they perform to provide products consumers (Sheehan and Foss, 2007). Moreover, industry analysis only consider of two general strategies to achieve superior positions which are to produce at lower cost with good quality and seduce customers to pay a price above-average without incurring higher production costs (Sheehan and Foss, 2007). While RBV sees firms resources as an essential key in achieving competitive advantage, Porters analysis argues that the main determinant to achieve competitive advantage is the activities a firm can perform. In other words, Porter argues that some industries can be more profitable than others by either manipulating the forces driving competition or by selecting these structural attractive industries could earn monopoly rents. The industry analysis is best employed for a firms current form of activities, while RBV is best applied for a firms current resource portfolio. To support managers in interpreting, implementing and improving a low cost of differentiation strategy, Porter had constructed the value chain network. But when it comes to following his logic of two general strategies, managers face difficulties while trying to carry out the drivers. First the managers must equilibrate manifold drivers across manifold activities; second managers must operationalise the understanding in the particular situation of a firm. For example, the scale of manufacturing operations (i.e. policy choices, capacity utilisation, etc.) has to be equilibrated with the other drivers of other activities (i.e. transportation cost) and associated with its competitors (i.e. potential to no-win situation) (Sheehan and Foss, 2007). Conclusion In conclusion, the firms core resources and the duty of management in utilising its resources to achieve sustainable competitive advantage and leading to superior performance in the industries are the essential elements of the resource-based view of the firm. Key resources have been identified as tangible assets, intangible assets (such as client loyalty and relationship) and capabilities (such as skills and knowledge) (Clulow and Gerstman, 2007). While RBV has the relationship with firms performance in achieving a sustainable competitive advantage, it does not have a strong relationship in achieving SCA, because RBV is not a theory of value creation and has some limitations as a strategic tool. However, comparing Porters Industry Analysis with RBV in achieving SCA, RBV model is better because it offer less complexity in formulating and implementing firm strategy to achieve desired position. Appendices Appendix 1 Appendix 2